A Tumor Ultrasound – Guided Incision (TUGI) Approach to Nipple Sparing Mastectomy: Balancing Oncologic Safety and Technical Outcomes

• Published in: Clinical breast cancer Vol. 17; no. 7; pp. 572 - 577
• Main Authors: Fernando, Emil J., MD, Eskenazi, Benjamin R., MD, Djohan, Risal S., MD, Grobmyer, Stephen R., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2017
• Subjects: Adult; Breast cancer; Breast Implants; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast reconstruction; Endosonography - methods; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Image-Guided Biopsy - methods; Incision; Mammaplasty; Margins; Mastectomy - methods; Medical Oncology; Nipples - surgery; Obstetrics and Gynecology; Organ Sparing Treatments - methods; Prognosis; Retrospective Studies; Total skin sparing mastectomy; Incision; Margins; Breast cancer; Total skin sparing mastectomy; Breast reconstruction
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2017.04.003

Abstract Background Nipple sparing mastectomy (NSM) is a prevalent operation for breast cancer patients. Indications have been limited to tumors accessible via radial, infra-mammary, or periareolar incisions out of concern for oncologic and technical safety. We study an alternative approach to NSM based on tumor ultrasound-guided incisions (TUGI) and report its oncologic and technical outcomes. Materials and Methods A retrospective chart review examined patients who underwent TUGI NSM between 2013 and 2016. Operative notes, post-operative notes, pathology reports, and post-operative photography were analyzed. Results 94 patients had mastectomy with reconstruction performed over a 3-year period by the senior authors. Of those, 31 (33%) were NSM and 13 (14%) had the TUGI technique, forming the study group. Median tumor size was 1.5cm, with a median distance from the nipple areolar complex (NAC) of 5cm. 62% of the incisions were in the upper quadrants of the breast. Median operative time was 207 min. 0 patients had positive margins. 62% of the incisions were in the upper quadrants of the breast. 100% of patients underwent immediate tissue expander (TE) placement, 46% with acellular dermal matrix. For final reconstruction, 23% had a free flap, 69% implant, and 8% are still pending. 8% of patients had wound infection, and 15% of patients had NAC necrosis. No cancer recurrence has been observed at a median follow-up of 17 months. Conclusions TUGI offers a valuable, oncologically sound alternative approach to traditional NSM. The technical results and outcomes support its use in selected patients with breast cancer undergoing NSM.